Sunday, Sep 26 - Expo Hall Opening
Sunday, Sep 26 - Job Fair
Monday,
Sep 27 - AWHONN's Block Party
Sunday, September 26, 2010
Title: Seriously Blue: Initiating a Perinatal Depression Screening Protocol in a Community Hospital
Discipline: Childbearing (CB)
Learning Objectives:
Submission Description:- Explore an innovative way to identify perinatal women at risk for depression
- Assess patient and family resources available related to perinatal depression support
- Be familiar with a formal nursing education tool developed to promote understanding of perinatal depression
Rationale for program
Perinatal depression, which encompasses major and minor depressive episodes occurring either during pregnancy or within the first 12 months following delivery, can have devastating consequences for both a woman and her family. Although an estimated 1 in 5 women suffer from perinatal depression, barriers to care including lack of screening and surveillance, along with stigma of reporting symptoms by women, results in approximately 80% of undiagnosed cases. Applying the national incidence rate of 6.5% to 13% to this large community hospital, it is estimated that 200 to 425 of the 3500 obstetrical patients a year may suffer from depression. Currently, only one obstetrical office associated with this hospital routinely screens for perinatal depression.
Purpose of the Program:
Short-term goals include initiating a nursing protocol to provide resources for screening, education and referral to treatment of perinatal depression for all obstetrical patients at this community hospital, as well as ongoing support and education for nursing staff caring for these patients.
Proposed change:
1. Initiate an interdisciplinary task force to develop an evidence-based protocol for depression screening of all obstetrical patients.
2. To improve patient and family education regarding perinatal depression and to identify local, state and national resources for patient support.
3. To develop a formal nursing education tool and unit resource related to perinatal depression.
Implementation and Evaluation Strategies:
Screening tools were reviewed and the Edinburgh Postnatal Depression Scale (EPDS) was chosen to screen all obstetrical patients within 24 hours of admission (or as soon thereafter as condition allows). Nursing protocols were written, including suggested script for presenting screening scale to patients. Screening results were incorporated into current nursing computer documentation, including automatic social work referral for high EPDS scores. Ongoing screening for long-term Antepartum patients and also for Moms of Neonatal Intensive Care Unit babies was also included. Family pledge cards describing depression symptoms, developed elsewhere and used with permission, will be distributed at prenatal classes and during hospitalization. Community resources were gathered and will be attached to the current postpartum depression literature given to patients. A comprehensive mandatory nursing inservice was developed and placed on each nursing unit to be completed over the course of one month prior to beginning screening. Nursing feedback during the first two months will be considered for initial evaluation of the program and changes made as appropriate.
Implications for Nursing Practice
Nurses have a responsibility to assist all perinatal patients by assessing their psychosocial and emotional needs, and linking them to appropriate support. Administering the EPDS, along with patient and family education, are important first steps in addressing perinatal depression within this hospital setting. Chart audits will be used to document EPDS scores and social work referrals made. Clearly nursing research along with patient care can benefit from implementation and descriptive documentation of this program. Finally, long-term goals involve promoting depression screening in all Obstetrician offices associated with this hospital as well as supporting a collaborative network within the community dedicated to improving the mental health of perinatal women.
Perinatal depression, which encompasses major and minor depressive episodes occurring either during pregnancy or within the first 12 months following delivery, can have devastating consequences for both a woman and her family. Although an estimated 1 in 5 women suffer from perinatal depression, barriers to care including lack of screening and surveillance, along with stigma of reporting symptoms by women, results in approximately 80% of undiagnosed cases. Applying the national incidence rate of 6.5% to 13% to this large community hospital, it is estimated that 200 to 425 of the 3500 obstetrical patients a year may suffer from depression. Currently, only one obstetrical office associated with this hospital routinely screens for perinatal depression.
Purpose of the Program:
Short-term goals include initiating a nursing protocol to provide resources for screening, education and referral to treatment of perinatal depression for all obstetrical patients at this community hospital, as well as ongoing support and education for nursing staff caring for these patients.
Proposed change:
1. Initiate an interdisciplinary task force to develop an evidence-based protocol for depression screening of all obstetrical patients.
2. To improve patient and family education regarding perinatal depression and to identify local, state and national resources for patient support.
3. To develop a formal nursing education tool and unit resource related to perinatal depression.
Implementation and Evaluation Strategies:
Screening tools were reviewed and the Edinburgh Postnatal Depression Scale (EPDS) was chosen to screen all obstetrical patients within 24 hours of admission (or as soon thereafter as condition allows). Nursing protocols were written, including suggested script for presenting screening scale to patients. Screening results were incorporated into current nursing computer documentation, including automatic social work referral for high EPDS scores. Ongoing screening for long-term Antepartum patients and also for Moms of Neonatal Intensive Care Unit babies was also included. Family pledge cards describing depression symptoms, developed elsewhere and used with permission, will be distributed at prenatal classes and during hospitalization. Community resources were gathered and will be attached to the current postpartum depression literature given to patients. A comprehensive mandatory nursing inservice was developed and placed on each nursing unit to be completed over the course of one month prior to beginning screening. Nursing feedback during the first two months will be considered for initial evaluation of the program and changes made as appropriate.
Implications for Nursing Practice
Nurses have a responsibility to assist all perinatal patients by assessing their psychosocial and emotional needs, and linking them to appropriate support. Administering the EPDS, along with patient and family education, are important first steps in addressing perinatal depression within this hospital setting. Chart audits will be used to document EPDS scores and social work referrals made. Clearly nursing research along with patient care can benefit from implementation and descriptive documentation of this program. Finally, long-term goals involve promoting depression screening in all Obstetrician offices associated with this hospital as well as supporting a collaborative network within the community dedicated to improving the mental health of perinatal women.
